Bone stabilization systems

ABSTRACT

Bone plates for engaging bone members are described herein. The bone plates can receive one or more screws to secure the bone plates to an underlying bone member. The one or more screws can be inserted into bone plate holes that can be considered locking or non-locking. The bone plates described herein can have particular combinations of locking and/or non-locking holes. In addition, instruments such as distal and proximal aiming guides can accompany the bone plates to guide one or more screws into the bone plates.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.16/444,345, filed on Jun. 18, 2019, which is a continuation of U.S.patent application Ser. No. 15/882,303, filed on Jan. 29, 2018, which isa continuation-in-part of U.S. patent application Ser. No. 15/592,912,filed on May 11, 2017, which is a non-provisional application thatclaims priority to U.S. Provisional Application 62/470,470, filed Mar.13, 2017, the entireties of which are herein incorporated by reference.

FIELD OF THE INVENTION

The present disclosure relates to surgical devices, and moreparticularly, stabilization systems including plates, for example, fortrauma applications.

BACKGROUND OF THE INVENTION

Bone fractures can be healed using plating systems. During treatment,one or more screws are placed on either side of a fracture, therebycausing compression and healing of the fracture. There is a need forimproved plating systems as well as mechanisms for accurate use of theplating systems.

Additionally, modern improvements in the treatment of bone deformitiesand comminuted traumatic fractures called for the establishment of“normal” mechanical axes of the human skeleton. Multiple authorspublished results of their anatomic studies with a variety ofnomenclatures. Eventually, nomenclature was standardized and nominal andextreme values for “normal” mechanical and anatomic axes were settledon. These established angles are used now by medical professionals, suchas orthopedic surgeons, around the world as a reference for correctingdeformity and restoring normal joint alignment post-trauma. While someexisting software packages aid with this correction in the evaluation ofx-rays, there are no currently available devices for use underfluoroscopy in the operating room.

SUMMARY OF THE INVENTION

In accordance with the application, a system for treating a fracture ina bone is provided. In some embodiments, the system comprises: a boneplate configured to engage the bone, the bone plate comprising aproximal end, a distal end, a head portion, a neck portion and a shaftportion, wherein the head portion comprises a first row of holes and asecond row of holes for receiving one or more fasteners therein, whereinthe shaft portion comprises at least one additional hole for receiving afastener therein; at least one fastener received in the head portion andpositioned in the first row of holes or second row of holes; and atleast one fastener received in the shaft portion and positioned in theat least one additional hole.

In other embodiments, the system comprises: a bone plate configured toengage the bone, the bone plate comprising a proximal end, a distal end,a head portion, a neck portion and a shaft portion, wherein the headportion comprises a first row of holes and a second row of holes forreceiving one or more fasteners therein, wherein the shaft portioncomprises at least one additional hole for receiving a fastener therein;at least one fastener received in the head portion and positioned in thefirst row of holes or second row of holes, wherein the at least onefastener is non-threaded; and at least one fastener received in theshaft portion and positioned in the at least one additional hole.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete understanding of the present invention, and theattendant advantages and features thereof, will be more readilyunderstood by reference to the following detailed description whenconsidered in conjunction with the accompanying drawings, wherein:

FIG. 1 is a top perspective view of a bone plate in accordance with someembodiments.

FIG. 2A is a top view of a head of the bone plate of FIG. 1.

FIG. 2B is a bottom view of a head of the bone plate of FIG. 1.

FIG. 3 is a side perspective view of a head of the bone plate of FIG. 1.

FIG. 4 is a view of the bone plate of FIG. 1 attached to a bone.

FIG. 5 is an alternative view of the bone plate of FIG. 1 attached to abone.

FIG. 6 is a top view of a shaft of the bone plate of FIG. 1 with across-sectional view shown beneath.

FIG. 7 is a top perspective view of an alternative bone plate inaccordance with some embodiments.

FIG. 8 is a top perspective view of an alternative bone plate inaccordance with some embodiments.

FIG. 9 is a top perspective view of an alternative bone plate inaccordance with some embodiments.

FIG. 10 is a top perspective view of an alternative bone plate inaccordance with some embodiments.

FIG. 11 is a top perspective view of an alternative bone plate inaccordance with some embodiments.

FIG. 12 is a top perspective view of an alternative bone plate inaccordance with some embodiments.

FIG. 13 is a top perspective view of an alternative bone plate inaccordance with some embodiments.

FIG. 14 is a top perspective view of an alternative bone plate inaccordance with some embodiments.

FIG. 15 is a top perspective view of an alternative bone plate inaccordance with some embodiments.

FIG. 16 is a top perspective view of an alternative bone plate inaccordance with some embodiments.

FIG. 17 is a top perspective view of an aiming guide in accordance withsome embodiments.

FIG. 18 is a side view of a mount of the aiming guide of FIG. 17.

FIG. 19 is an alternative side view of a mount of the aiming guide ofFIG. 17.

FIG. 20 is a top perspective view of an aiming guide comprising a distalaiming guide and an optional proximal aiming guide in accordance withsome embodiments.

FIG. 21 is a top perspective view of the aiming guide of FIG. 20.

FIG. 22 is a bottom perspective view of an attachment post in accordancewith some embodiments.

FIG. 23 is a top perspective view of the proximal aiming guide of FIG.20.

FIG. 24 is a top perspective view of the distal aiming guide withoptional proximal aiming guide of FIG. 20.

FIG. 25A is a view of the distal aiming guide with proximal aiming guidein a first setting.

FIG. 25B is a view of the distal aiming guide with proximal aiming guidein a second setting.

FIG. 25C is a view of the distal aiming guide with proximal aiming guidein a third setting.

FIG. 25D is a view of the distal aiming guide with proximal aiming guidein a fourth setting.

FIG. 26 is a cross-sectional view of a dial in the proximal aimingguide.

FIG. 27 is a top perspective view of dial in the proximal aiming guide.

FIG. 28 is a front view of a bone plate including rafting screwsattached to a bone member.

FIG. 29 is a side view of the bone plate of FIG. 28.

FIG. 30 is a top view of the bone plate of FIG. 28.

FIG. 31 is a top perspective view of a rafting blade in accordance withsome embodiments.

FIG. 32 is a top view of the rafting blade of FIG. 31.

FIG. 33 is a side view of the rafting blade of FIG. 31.

FIG. 34 is a side view of a pair of rafting blades attached to a platein accordance with some embodiments.

FIG. 35A is a front view of the rafting blade of FIG. 31.

FIG. 35B is a bottom perspective view of the rafting blade of FIG. 31.

FIG. 36 is a top perspective view of an insertion guide for raftingblades in accordance with some embodiments.

FIGS. 37A and 37B is the insertion guide detached from the raftingblades of FIG. 36.

FIGS. 38A and 38B is the rafting blades following insertion inaccordance with some embodiments.

FIG. 39 is a top perspective view of rafting blades and an independentsupport screw in accordance with some embodiments.

FIG. 40A is a front view of a blocking mechanism for the rafting bladesin accordance with some embodiments.

FIG. 40B is a front view of the blocking mechanism of FIG. 40A rotated.

FIG. 41 is a side view of a rafting blade and locking cap in accordancewith some embodiments.

FIG. 42 is a top perspective view of the rafting blade attached to thelocking cap of FIG. 41.

FIG. 43 is a top perspective view of the locking cap of FIG. 41.

FIG. 44 is a top perspective view of a rafting blade having deformingridges in accordance with some embodiments.

FIG. 45 is a bottom perspective view of the rafting blade havingdeforming ridges of FIG. 44.

FIG. 46 is a diagram showing an alternate embodiment of an aiming guideaccording to one embodiment of the present invention.

FIG. 47 is a diagram showing a detailed view of the aiming guideaccording to one embodiment of the present invention.

FIGS. 48A-48C show one embodiment of the attachment post and threadedshaft in more detail.

FIGS. 49A-49B are diagrams showing exemplary tissue protection sleevesaccording to one embodiment of the present invention.

FIG. 50 is a diagram showing exemplary instruments passing throughtissue protection sleeves that have been inserted into the guide holesof the aiming arm.

FIG. 51A is a top perspective view of the proximal aiming guide.

FIG. 51B is a diagram showing another top perspective view of theproximal aiming guide.

FIG. 52 shows one exemplary embodiment of a guide according to thepresent invention.

FIG. 53 is a diagram showing a more detailed view of a frontal plane(AP) guide mechanical and anatomic reference angles according to oneembodiment of the present invention.

FIGS. 54-57 are diagrams showing examples of the guide being used tomeasure anatomic angles during interoperative use.

FIG. 58 is a diagram showing another embodiment of guide according toone aspect of the present invention.

FIGS. 59-60 are diagrams showing the guide of FIG. 58 duringintraoperative use.

FIG. 61 is a diagram showing a guide that includes dotted referencelines indicating the limits of each mechanical and anatomic axis.

FIG. 62A is a diagram showing an exemplary sagittal and frontal guidethat are formed as a single, foldable element.

FIG. 62B is a diagram showing an exemplary frontal and sagittal guidesthat are positioned adjacent to one another.

FIG. 63 is a diagram showing an exemplary embodiment of a guide thatincludes one or more perforations.

FIG. 64 illustrates an embodiment in which a guide is shown with in acase.

FIG. 65 illustrates the rectangular panels according to one exemplaryembodiment of a guide.

DETAILED DESCRIPTION OF THE INVENTION

Embodiments of the present application are generally directed todevices, systems and methods for bone stabilization. In particular,embodiments are directed to bone plates that extend across bone membersto treat one or more fractures.

The plates described herein may be adapted to contact one or more of afemur, a distal tibia, a proximal tibia, a proximal humerus, a distalhumerus, a clavicle, a fibula, an ulna, a radius, bones of the foot,bones of the hand, or other suitable bone or bones. The bone plates maybe curved, contoured, straight, or flat. The plates may have a headportion that is contoured to match a particular bone surface, such as ametaphysis or diaphysis, flares out from the shaft portion, forms anL-shape, T-shape, Y-shape, etc., with the shaft portion, or that formsany other appropriate shape to fit the anatomy of the bone to betreated. The plates may be adapted to secure small or large bonefragments, single or multiple bone fragments, or otherwise secure one ormore fractures. In particular, the systems may include a series oftrauma plates and screws designed for the fixation of fractures andfragments in diaphyseal and metaphyseal bone. Different bone plates maybe used to treat various types and locations of fractures.

The bone plates may be comprised of titanium, stainless steel, cobaltchrome, carbon composite, plastic or polymer—such aspolyetheretherketone (PEEK), polyethylene, ultra high molecular weightpolyethylene (UHMWPE), resorbable polylactic acid (PLA), polyglycolicacid (PGA), combinations or alloys of such materials or any otherappropriate material that has sufficient strength to be secured to andhold bone, while also having sufficient biocompatibility to be implantedinto a body. Similarly, the bone plates may receive one or more screwsor fasteners that may be comprised of titanium, cobalt chrome,cobalt-chrome-molybdenum, stainless steel, tungsten carbide,combinations or alloys of such materials or other appropriatebiocompatible materials. Although the above list of materials includesmany typical materials out of which bone plates and fasteners are made,it should be understood that bone plates and fasteners comprised of anyappropriate material are contemplated.

The bone plates described herein can be considered “locking” or“non-locking” plates. Locking plates include one or more openings foraccepting one or more locking fasteners. The one or more openings can bepartially or fully threaded. In some embodiments, these openings includefully threaded or stacked openings, which accept both locking andnon-locking fasteners. In some embodiments, the locking fastenersinclude heads that are at least partially threaded. The lockingfasteners can be monoaxial or polyaxial. One non-limiting example of alocking fastener (among others) is shown in FIG. 6 of U.S. applicationSer. No. 15/405,368, filed Jan. 13, 2017, which is hereby incorporatedby reference in its entirety.

Non-locking plates include one or more openings for accepting one ormore non-locking fasteners. The one or more openings at least in part benon-threaded. In some embodiments, these openings include non-threadedor stacked openings, which accept both locking and non-lockingfasteners. In some embodiments, the non-locking fasteners include headsthat are non-threaded. The non-locking fasteners can be monoaxial orpolyaxial. One non-limiting example of a non-locking fastener (amongothers) is shown in FIG. 4 of U.S. application Ser. No. 15/405,368,filed Jan. 13, 2017, which is hereby incorporated by reference in itsentirety. In some embodiments, the non-locking fasteners can includedynamic compression screws, which enable dynamic compression of anunderlying bone.

Below are various examples of locking and non-locking plates attachableto bone. In some embodiments, locking plates may be thicker thannon-locking plates. Locking plates may be useful for patients that haveweaker bone, while non-locking plates may be useful for patients thathave strong bone.

The locking and non-locking plates described below can be attached todifferent bones to treat fractures. In particular, the locking andnon-locking plates can be used to treat fractures of the tibia, thoughone skilled in the art will appreciate that the novel plates describedherein can be applied to fractures on other types of bone as well. Withrespect to the tibia, the locking and non-locking plates can beconsidered to be lateral, medial or posteromedial plates. In otherwords, the plates can be attached to a lateral, medial or posteromedialaspect of a tibia. One skilled in the art will appreciate, however, thatthe plates are not limited to their specific locations on the tibia, andthat a surgeon may choose to apply a lateral plate medially or a medialplate laterally, if desired. In the present application, the bone platesshown in FIGS. 1 and 7-10 can be viewed as lateral plates, while thebone plates shown in FIGS. 11-17 can be viewed as medial orposteromedial plates.

FIG. 1 is a top perspective view of a bone plate in accordance with someembodiments. In some embodiments, the bone plate 10 comprises a laterallocking plate, wherein at least some of the fasteners received thereinare locking fasteners. The bone plate 10 comprises a proximal end 12 anda distal end 14. The bone plate 10 further comprises a head portion 22,a shaft portion 26, and a transitionary neck portion 24 between the headportion 22 and the shaft portion 26.

The head portion 22 comprises a widest portion of the bone plate 10 andis adjacent the proximal end 12. In some embodiments, the proximal end12 is chamfered. Advantageously, the proximal end 12 contour and chamferhelps to position the bone plate 10 posterior to Gerdy's tubercle tominimize soft tissue irritation in a highly affected area. In someembodiments, the head portion 22 will be placed on a bone member (e.g.,tibia) near an articular surface. Certain features of the head portion22 are advantageously designed to prevent or resist subsidence of anarticular surface. The head portion 22 comprises a first row of holes 32and a second row of holes 34. In some embodiments, these holes 32, 34are considered to be “rafting” holes that can receive rafting screws(e.g., as shown in FIG. 30) that advantageously support an articularsurface of a joint and prevent subsidence. In some embodiments, theholes 32, 34 are locking holes that are at least partially threaded anddesigned to receive one or more polyaxial locking screws.

As shown in FIG. 1, the head portion 22 comprises a first row of holes32 and a second row of holes 34, wherein the second row of holes 34 arelarger than the first row of holes 32. For example, in some embodiments,the first row of holes 32 can be between 2.0 and 3.0 mm (e.g., 2.5 mm),while the second row of holes 34 can be between 3.0 and 4.0 mm (e.g.,3.5 mm). By providing two sets of holes 32, 34, the bone plate 10advantageously accommodates a greater number of rafting screws, therebyproviding greater support near a joint. In particular, the most proximalset of holes 32 are especially novel and advantageous, as they aredesigned to be adjacent the proximal end 12 of the bone plate 10. Theseholes 32 receive rafting screws that are closest to an articular surfaceof a joint. These holes 32 are advantageously smaller in size than holes34, such that they can accommodate smaller rafting screws, which may beparticularly hard to position in the limited space adjacent thearticular surface. In some embodiments, the first row of holes 32 areoffset from the second row of holes 34, while in other embodiments, thefirst row of holes 32 are aligned with the second row of holes 34. Insome embodiments, the first row of holes 32 can have the same number ofholes as the second row of holes, while in other embodiments, the firstrow of holes 32 can have a different number of holes as the second rowof holes. In the present embodiment, the bone plate 10 include fourholes 32 and four holes 34.

As shown in FIG. 1, the head portion 22 further comprises one or morenovel multi-purpose holes 36. In some embodiments, the multi-purposeholes 36 are advantageously designed to accommodate a k-wire as well asa suture. In some embodiments, the holes 36 are sized and positioned toreceive a k-wire therein, thereby assisting in placement of the boneplate 10 on a bone member. The holes 36 are formed adjacent andcontinuously with one or more undercuts 37 (shown in FIGS. 2B and 3) ofthe bone plate 10. As shown in FIG. 5, the one or more undercuts 37advantageously allow access to one or more sutures through the boneplate 10 even after the bone plate 10 is implanted on bone. The suturescan be used to attach the bone plate 10 to adjacent tissue, therebyfurther securing the bone plate 10 at or near a surgical site.

The neck portion 24 is a transitionary portion between the head portion22 and the shaft portion 26. The neck portion 24 is less wide than thehead portion 22, but has at least some portions that of equal or greaterwidth than the shaft portion 26. As shown in FIG. 1, the neck portion 24comprises a pair of locking holes 42, an instrument attachment hole 44,alignment indentations 46, a positioning slot, and three kickstand holes52. Each of these features is described below.

The pair of locking holes 42 are positioned beneath the rafting holes32, 34. In some embodiments, the locking holes 42 comprise polyaxiallocking holes that are at least partially threaded. The pair of lockingholes 42 are configured to receive one or more bone fasteners or screwsto secure the bone plate 10 to an underlying bone member. In someembodiments, the pair of locking holes 42 are the same or similar widthto the holes 34. In some embodiments, each of the locking holes 42 has awidth between 3.0 and 4.0 mm (e.g., 3.5 mm).

Below the pair of locking holes 42 are indentations 46 and an instrumentattachment hole 44. The indentations 46 and instrument attachment hole44 are designed to cooperate with an aiming guide, as shown in FIGS. 18and 21. The aiming guide is particularly useful with lateral plates, andcan be used to accurately guide one or more bone screws or fastenersinto respective holes in a bone plate 10. In some embodiments, theindentations 46 comprise spherical indentations. Unlike other holes oropenings in the bone plate 10, the indentations 46 do not extendcompletely through a plate. Rather, the indentations 46 are engaged byone or more ball-end pins (shown in FIG. 22) that extend outwardly froman attachment post of an aiming guide. The indentations 46advantageously help to stabilize and position the aiming guide relativeto the bone plate 10. While the bone plate 10 is shown as having threeindentations 46, the bone plate 10 can include one, two, or more thanthree indentations 46. Between the indentations 46 is an instrumentattachment hole 44. The instrument attachment hole 44 comprises athreaded hole that is designed to receive a threaded shaft (shown inFIG. 22) that also extends outwardly from an attachment post of anaiming guide. Once the aiming guide is stabilized via the indentations46, the aiming guide can be attached to the bone plate 10 via threadingof the threaded shaft.

A positioning slot 48 is located distally and beneath the indentations46 and instrument attachment hole 44. The positioning slot 48 comprisesan elongated opening that is designed to receive a first bone screw orfastener therein before finalizing a position of a bone plate 10 onbone. As the positioning slot 48 is elongated, the bone plate 10 can beslightly adjusted around a first bone fastener is needed. In someembodiments, the positioning slot 48 has a length that is greater than alength of any of the other holes that receive bone screws therein. Insome embodiments, the positioning slot 48 has a length that is at leasttwice the length of a length of any of the other holes that receive bonescrews therein. The first bone fastener can be provisionally placed inthe positioning slot 48 prior to final tightening of the first bonescrew. Upon proper orientation and placement of the bone plate 10, thefirst bone fastener can be finally tightened.

One or more kickstand holes 62 are provided distally from thepositioning slot 48. In some instances, lateral plates may be preferredover medial plates, as they can often be implanted via a smallerincision with less risk to surrounding tissue. The one or more kickstandholes 62 are capable of receiving one or more bone fasteners that cantreat medial fractures if desired. In other words, the kickstand holes62 advantageously allow a medial fracture to be treated via support fromjust the lateral side. As shown in FIG. 1, the bone plate 10 includes atleast three kickstand holes 62. In some embodiments, the kickstand holes62 are fixed angle, stacked locking holes. By providing a triplekickstand construct with three kickstand holes 62, this advantageouslyaccommodates up to three bone fasteners to better support a medialfracture. In some embodiments, the triple kickstand construct serves asa novel collection of kickstand holes 62 aimed at the anterior, middle,and posterior aspects of the medial proximal tibia, thereby providingthe surgeon with options and enhanced versatility. The triple kickstandconstruct advantageously provides a surgeon with options for whichfragments to target and allows the surgeon to customize constructrigidity with one or more screws or fasteners. In other embodiments, thekickstand construct will have a single kickstand hole, two kickstandholes, or more than three kickstand holes.

The shaft portion 26 comprises a distal portion of the bone plate 10relative to the head portion 22 and neck portion 24. In someembodiments, the shaft portion 26 comprises a longest and narrowestportion of the bone plate 10. The shaft portion 26 comprises a number ofopenings or holes therein for receiving one or more bone fasteners. Inthe present embodiment, the shaft portion 26 comprises a plurality ofholes 62 (e.g., five) that serve as fixed angled, stacked locking holes.These fixed angle, stacked locking holes allow mono-axial insertion ofbone fasteners that can be locking or non-locking. In addition, as shownin FIG. 1, the shaft portion 26 of the bone plate 10 also comprises abi-direction, dynamic compression slot 64 that is positioned in betweenthe locking holes 62. The bi-directional dynamic compression slot 64advantageously allows for static insertion of non-locking screws intothe shaft of bone. They also allow for compression (e.g., 0.5 mm-2 mm)along the shaft of the bone through eccentric insertion of a non-lockingscrew. The holes 62 and slot 64 are capable of receiving one or morescrews therein to secure the bone plate 10 to bone.

The distal portion of the shaft portion 26 further comprises a taperedtip 18. In some embodiments, the tapered tip 18 serves as an insertiontip that allows the plate 10 to be inserted beneath skin to a surgicalsite. The bone plate 10 can be positioned adjacent to bone (e.g., atibia), whereby it can be fixed to the bone. In some embodiments, thetapered tip allows for simplified submuscular plate insertion tominimize incision length. As shown in FIG. 1, an underside of the shaftportion 26 of the bone plate 10 comprises a plurality of scallops 66.The scallops 66 form a scalloped contact surface which provides betterfrictional contact with a bone member. In some embodiments, thescalloped contact surface minimizes impact to the periosteal bloodsupply and allows some bending of the shaft portion 26 of the bone plate10 without deforming threaded holes.

In some embodiments, the bone plate 10 provides an anatomic contour thataccommodates a lateral aspect of the proximal tibia. In someembodiments, the bone plate 10 includes a proximal anterior portion(e.g., chamfered portion) that sits just posterior to Gerdy's tubercle,thereby assisting with positioning while minimizing soft tissueirritation.

FIG. 2A is a top view of a head of the bone plate of FIG. 1. The headportion 22 comprises a widest most portion of the bone plate 10. Asshown in FIG. 2A, the head portion 22 accommodates a first row of holes32 a, 32 b, 32 c, 32 d and a second row of holes 34 a, 34 b, 34 c, 34 d.As noted above, the first row holes of holes and second row of holes canserve as “rafting” holes to accommodate rafting screws therein. In someembodiments, the first row of holes 32 are smaller than the second rowof holes 34. In addition, in some embodiments, the first row of holes 32are offset from the second row of holes 34. As shown in FIG. 2A, a pairof novel multi-purpose holes 36 a, 36 b are also provided through thehead portion 22 of the bone plate 10. The multi-purpose holes 36 a, 36 bare each configured to receive a k-wire and/or suture therethrough. Alsoshown in FIG. 2A are features of the neck portion 24, including thelocking holes 42 a, 42 b, the indentations 46 a, 46 b, 46 c and theinstrument attachment hole 44.

FIG. 2B is a bottom view of a head of the bone plate of FIG. 1. From thebottom view, one can see the underside of the head portion 22 of thebone plate 10. In particular, one can see the underside of themulti-purpose holes 36 a, 36 b and how they are formed adjacent andcontinuously with undercuts 37 a, 37 b formed on the bone plate 10. Asshown in FIG. 5, the undercuts 37 a, 37 b advantageously allow a sutureto be threaded between a bone plate 10 and an underlying bone 2, evenwhen the bone plate 10 is positioned adjacent the bone 2. As shown inFIG. 2B, the undercuts 37 a, 37 b surround the perimeters of each of themulti-purpose holes 36 a, 36 b.

FIG. 3 is a side perspective view of a head of the bone plate of FIG. 1.From this view, one can see the curved angle of the head portion 22 ofthe bone plate 10. In addition, one can see how the undercuts 37 a, 37 bfollow the curved contour of the bone plate 10 and are curvedthemselves.

FIG. 4 is a view of the bone plate of FIG. 1 attached to a bone. Thebone plate 10 includes a plurality of screws or fasteners 6 receivedtherein. Screws 6 that are received in the holes 32 a, 32 b, 32 c, 32 d,as well as in the holes 34 a, 34 b, 34 c, 34 d, can be consideredrafting screws. As shown in FIG. 4, the rafting screws are positionedclose to an articular surface 4 of the bone 2 (e.g., tibia) andadvantageously help to provide support for the articular surface 4. Inother words, the rafting screws help to serve as rebar for the articularsurface 4. From this view, one can also see a suture undercut 37 a thatis formed at a corner of the bone plate 10.

FIG. 5 is an alternative view of the bone plate of FIG. 1 attached to abone. From this view, one can see how the undercut 37 forms an openingbetween the bone plate 10 and bone 2 such that there is access to threada suture even when the bone plate 10 is implanted on bone 2.

FIG. 6 is a top view of a shaft of the bone plate of FIG. 1 with across-sectional view shown beneath. The shaft portion 26 includes anumber of holes or openings for receiving different bone screws (e.g.,locking or non-locking) therein. In some embodiments, the shaft portion26 can vary in length to accommodate different bones in different sizedpatients. As shown in FIG. 6, each of the vertical perforated linesrepresents a possible cutoff or end of a bone plate 10. For patientswith smaller bones, the cut-off could be sooner, while for patients withlarger bones, the cut-off could be later. In some embodiments, the shaftportion 26 accommodates a unique hole or opening pattern whereby thehole immediate preceding a plate end will be a fixed angle, stacked hole62. By providing a stacked hole 62 that precedes a plate end, the boneplate 10 can accommodate either a locking or a non-locking screw,thereby providing a large number of options for a surgeon implanting theplate. In some embodiments, the novel pattern of holes or openings inthe shaft portion 26 includes holes that are spaced apart (e.g., 12-14mm) center-to-center and allows plate lengths to be offered in two-holeincrements while maintaining that the last hole will always be a stackedhole. In some embodiments, bi-directional compression slots 64 can beworked into the hole pattern, but can appear less than the stacked holes62 as they may be used less frequently. The unique hole patternmaximizes equidistant locking and non-locking options in the shaftportion 26 while still providing dynamic compression capabilities. Inaddition, the last hole before the plate end allowing a staticallyplaced locking or non-locking screw is preserved in all two-hole plateincrements, as shown in FIG. 6.

FIG. 7 is a top perspective view of an alternative bone plate inaccordance with some embodiments. In some embodiments, the bone plate 10comprises a lateral non-locking plate wherein at least some of holes oropenings therein receive non-locking fasteners. The bone plate 10includes similar features to the bone plate in FIG. 1, including aproximal end 12 and a distal end 14, a head portion 22, a neck portion24 and a shaft portion 26. The head portion 22 accommodates differentsized rafting screws via a first row of rafting holes 32 and a secondrow of rafting holes 34. The head portion 22 also includes multi-purposeholes 34 capable of receiving a k-wire and/or suture therein. However,the bone plate 10 can include additional non-locking holes for receivingnon-locking fasteners, as will be discussed in greater detail herein.

In some embodiments, the neck portion 24 can comprise holes 42 beneaththe rafting holes. The holes 42 comprise a trio of non-locking holescapable of receiving non-locking fasteners therein. Beneath the holes 42comprises an elongated positioning slot 48 for receiving a first bonescrew, as discussed above.

In some embodiments, the shaft portion 26 comprises a number ofnon-locking holes. Shaft portion 26 comprises a non-locking hole 62 forreceiving a non-locking fastener. In addition, shaft portion 26comprises a series of bi-directional dynamic compression slots 64 (whichcan also be viewed as non-locking openings) for receiving one or morebone fasteners therein. The distal end 14 of the bone plate 10 comprisesa tapered tip 18 that aids in insertion of the bone plate 10. Anunderside of the shaft portion 26 comprises a plurality of scallops 66.

FIG. 8 is a top perspective view of an alternative bone plate inaccordance with some embodiments. In some embodiments, the bone plate 10comprises a lateral plate 10 having one or more locking holes forreceiving locking fasteners. In some embodiments, the thickness of thelateral bone plate 10 varies from 2.2 mm proximally to 3.4 mm distally,with the thickness transition occurring in the neck of the bone plate10. The bone plate 10 includes many features as the bone plate in FIG.1, including a proximal end 12, a distal end 14, a head portion 22, aneck portion 24, and a shaft portion 26. The head portion 22 is thewidest portion of the bone plate 10 and includes a pair of rows ofrafting holes 32, 34, as well as a pair of multi-functional holes 36 forreceiving a k-wire and/or suture therein. The neck portion 24 is alsosimilar to that of the bone plate in FIG. 1, as it includes a pair ofpolyaxial locking holes 42, a trio of spherical alignment indentations46, a threaded instrument attachment hole 44, a positioning slot 48 anda trio of kickstand holes 52. However, the shaft portion 26 of the boneplate 10 of FIG. 8 comprises a different pattern of holes as will bediscussed herein.

As shown in FIG. 8, the shaft portion 26 comprises a plurality of holes62, 64. The holes 62 comprise fixed angle locking holes (e.g., 3.5 mm),while the adjacent holes 64 comprise dynamic compression slots. Theshaft portion 26 comprises several pairs of fixed angle locking holes 62adjacent the dynamic compression slots 64, which can be viewed asnon-locking.

FIG. 9 is a top perspective view of an alternative bone plate inaccordance with some embodiments. In some embodiments, the bone plate 10comprises a lateral plate 10 having one or more locking holes forreceiving locking fasteners. The bone plate 10 includes many features asthe bone plate in FIG. 1, including a proximal end 12, a distal end 14,a head portion 22, a neck portion 24, and a shaft portion 26. The headportion 22 is the widest portion of the bone plate 10 and includes apair of rows of rafting holes 32, 34. In contrast to the bone plate inFIG. 1, the head portion 22 includes a k-wire recess therein 22 that isseparate from a pair of suture holes 74.

The neck portion 24 is also similar to that of the bone plate in FIG. 1,as it includes a pair of polyaxial locking holes 42, a trio of sphericalalignment indentations 46, a threaded instrument attachment hole 44, apositioning slot 48 and a trio of kickstand holes 52. However, the shaftportion 26 of the bone plate 10 of FIG. 9 comprises a different patternof holes as will be discussed herein.

As shown in FIG. 9, the shaft portion 26 comprises a plurality of fixedangle, locking holes 62. Unlike the prior embodiments, there is nocompression slot or hole positioned adjacent the locking holes 62. Insome embodiments, the fixed angle, locking holes are spaced evenly,while in other embodiments, the fixed angle, locking holes are notspaced evenly. In addition to these locking holes 62, the shaft portion26 further comprises a tapered tip 18 and a scalloped contact surface.

FIG. 10 is a top perspective view of an alternative bone plate inaccordance with some embodiments. In some embodiments, the bone plate110 comprises a medial plate which can be placed on a bone (e.g., tibia)via a medial approach. In some embodiments, the thickness of the medialbone plate 110 varies from 2.2 mm proximally to 3.4 mm distally, withthe thickness transition occurring in the neck of the bone plate 110.The bone plate 110 comprises a proximal end 112 and a distal end 114. Ahead portion 122, neck portion 124 and shaft portion 126 extend betweenthe proximal end 112 and distal end 114.

The head portion 122 comprises a widest most portion of the bone plate110, and includes a series of holes 134 for receiving fasteners therein.In the present embodiment, the holes 134 comprise polyaxial lockingholes configured to receive one or more locking fasteners therein. Inthe present embodiment, the head portion 122 comprises four lockingholes 134. In other embodiments, the head portion 122 can comprise one,two, three or more than four locking holes 134. In some embodiments, theholes are between 2.5 mm and 4.5 mm, such as approximately 3.5 mm. Thehead portion 122 further comprises one or more k-wire openings 136. Thek-wire openings 136 (of which three are shown) are positioned near theproximal end 112 of the plate 110 and are configured to receive one ormore k-wires therethrough. In some embodiments, the head portion 122 canbe sized and configured to extend to an anterior portion of a bone (e.g,a tibia).

The neck portion 124 comprises a pair of holes 142 for receiving one ormore fasteners therein. In some embodiments, the holes 142 comprisepolyaxial locking holes that are between 2.5 mm and 4.5 mm (e.g., 3.5mm). In some embodiments, the locking holes are threaded so as toreceive one or more threaded locking fasteners. A positioning slot 148is positioned between the locking holes 142. The positioning slot 148 isan elongated slot (e.g., greater than two times the length of theadjacent holes 142) that is configured to receive a first screw therein.

The shaft portion 126 comprises a plurality of holes 162, as well as acompression slot 164. In some embodiments, the plurality of holes 162comprise fixed angle, stacked locking holes that are between 2.5 mm and4.5 mm, such as 3.5 mm. In some embodiments, the compression slot 1645comprises a bi-directional dynamic compression slot. The shaft portion126 further comprises a tapered tip 118 that assists the bone plate 110during insertion. In addition, the shaft portion 126 comprises anunderside having one or more scallops 166 forming a scalloped contactingsurface.

FIG. 11 is a top perspective view of an alternative bone plate inaccordance with some embodiments. In some embodiments, the bone plate110 comprises a medial plate. The bone plate 110 is similar to the boneplate in FIG. 10, and includes a proximal end 112, a distal end 114, ahead portion 122, a neck portion 124 and a shaft portion 126. However,the shape and size of the head portion 122 is distinguishable. Incontrast to the head portion of the bone plate in FIG. 10, which issubstantially symmetrical along a longitudinal axis of the bone plate,in FIG. 11, the head portion 122 is offset from a longitudinal axis ofthe bone plate. In some embodiments, the offset head allows the boneplate 110 to reach a posterior portion of a bone member (e.g., tibia).

FIG. 12 is a top perspective view of an alternative bone plate inaccordance with some embodiments. In some embodiments, the bone plate110 comprises a posteromedial plate that can be inserted through anincision over a posteromedial aspect of a bone (e.g., tibia). The boneplate 110 includes a number of similar features as the medial plates inFIGS. 10 and 11, including a proximal end 112, a distal end 114, a headportion 122, a neck portion 124, and a shaft portion 126. However, inthe present embodiment, the bone plate 110 includes several non-lockingholes 134 in the head portion 122, as well as several stacked lockingholes 162 in the shaft portion 126.

In particular, as shown in FIG. 12, the head portion 122 comprises a rowof non-locking holes 134 (e.g., between 2.5 mm and 4.5 mm) that arepositioned below a row of k-wire holes. In addition, the head portion122 comprises a single non-locking hole 142 positioned below the row ofnon-locking holes 134. The shaft portion 126 comprises a series of fixedangle, stacked locking holes 162 (e.g., between 2.5 mm and 4.5 mm)including a bi-directional dynamic compression slot 164 therebetween.

FIG. 13 is a top perspective view of an alternative bone plate inaccordance with some embodiments. In some embodiments, the bone plate110 comprises a medial plate that is inserted through an incision over amedial aspect of a bone (e.g., tibia). The bone plate 110 is similar tothe bone plate in FIG. 11, but includes a different hole pattern alongthe shaft portion 126. In the present embodiment, the shaft portion 126comprises several pairs of holes—a fixed angled locking hole 162(between 2.5 mm and 4.5 mm) adjacent a dynamic compression slot 164.

FIG. 14 is a top perspective view of an alternative bone plate inaccordance with some embodiments. In some embodiments, the bone plate110 comprises a medial plate that is inserted through an incision over amedial aspect of a bone (e.g., tibia). The bone plate 110 is similar tothe bone plate in FIG. 13, except the head portion 122 of the bone plate110 includes a plurality of non-locking holes 134, 142 (between 2.5 mmand 4.5 mm) rather than locking holes.

FIG. 15 is a top perspective view of an alternative bone plate inaccordance with some embodiments. In some embodiments, the bone plate110 comprises a medial plate that is inserted through an incision over amedial aspect of a bone (e.g., tibia). The bone plate 110 includes aproximal end 112, a distal end 114, a head portion 122, a neck portion124 and a shaft portion 126. The head portion comprises a row ofpolyaxial locking holes 134 (between 2.5 mm and 4.5 mm). The lockingholes 134 are formed distally beneath suture holes 174. The suture holes174 are independent from a recess 172 for a k-wire. The head portion 122also includes a fixed angle locking hole 142 (between 2.5 mm and 4.5mm). The neck portion 124 comprises a positioning slot 148 and anadditional fixed angle locking hole 142. The shaft portion 126 comprisesa plurality of alternating locked or unlocked holes 162 and compressionslots 164.

FIG. 16 is a top perspective view of an alternative bone plate inaccordance with some embodiments. In some embodiments, the bone plate110 comprises a posteromedial plate that is inserted through an incisionover a posteromedial aspect of a bone (e.g., tibia). The bone plate 110includes similar features as prior embodiments, including a head portion122 having polyaxial locking holes 134 (between 2.5 mm-4.5 mm), sutureholes 174 and a k-wire recess 172. The neck portion 124 includes a pairof fixed angle locking holes 142 (between 2.5 mm and 4.5 mm) and apositioning slot 148 therebetween. The shaft portion 126 comprises aseries of in-line openings or holes 162 that can accommodate a lockingor non-locking fastener therein.

In some embodiments, an aiming guide can be provided to assist a surgeonin placing one or more screws or fasteners into a patient. The aimingguide can be mounted to a bone plate, and can include guide holes thatalign with holes in the bone plate such that screws or fasteners can beaccurately implanted into a patient. In some embodiments, the guideholes can accept aiming sleeves that interface with drill guides,trocars, k-wires and screws. These sleeves can be secured to the aimingguide by a ratcheting or clipping mechanism. While the aiming guide canbe particularly useful for lateral plates, the aiming guide can also beused for medial and posteromedial plates.

FIG. 17 is a top perspective view of an aiming guide in accordance withsome embodiments. The aiming guide 200 can be mounted to an underlyingplate 10, and includes an aiming arm 210 and an aiming mount 230.

The aiming arm 210 comprises a plurality of guide holes 262 a, 262 b,262 c, 262 d that correspond with holes 62 a, 62 b, 62 c, 62 d of theplate 10. The purpose of the guide holes 262 is to help guide one ormore fasteners or screws into the corresponding holes 62 with precisionand accuracy. In some embodiments, the guide holes 262 can receiveaiming sleeves that interface with drill guides, trocars, k-wires orscrews. The aiming arm 210 includes an opening 264 on one end forreceiving an arm fixation bolt 236 therein and an opening 266 on theopposing end for receiving a distal locking bolt 238 therein. The armfixation bolt 236 is configured to extend and secure the aiming arm 210to the aiming mount 230. The distal locking bolt 238 is configured toengage an opening near a distal end of a bone plate 10, therebyproviding a stable construct. In some embodiments, the aiming arm 210 isformed of a non-metal, such as a carbon fiber. By forming the aiming arm210 of a non-metal, this advantageously prevents it from being visibleon an x-ray.

The aiming mount 230, which is attached to the aiming arm 210, serves asa mount on the plate 10. The aiming mount 230 (shown in FIGS. 18 and 19)comprises an upright post portion including a pair of openings 244 forreceiving an anti-rotation bolt 234 therein and an opening 244 forreceiving a fixation bolt 232 therein. The fixation bolt 232 serves toattach the aiming mount 230 (and thus the entire aiming guide 200) to aplate 10. The fixation bolt 232 can be received in an attachment hole 44(shown in FIG. 1) of the plate 10. The anti-rotation bolt 234 can beinserted into either of the mono-axial openings 244 to provideadditional rigidity during insertion. In some embodiments, the aimingmount 230 can be a different material from aiming arm 210, as the aimingmount 230 does not obstruct viewing of the holes 62 in the plate 10. Insome embodiments, the aiming mount 230 can be formed of metal while theaiming arm 210 can be formed of non-metal. The means of connecting theaiming arm 210 to the aiming mount 230 will not be described in moredetail.

FIG. 18 is a side view of a mount of the aiming guide of FIG. 17. Theaiming mount 230 comprises an upright post having an upper section and alower section. The upper section comprises a plurality of openings 235(shown in FIG. 19) for receiving stabilizing pins 240 therein. Theaiming arm 210 attaches to the aiming mount 230 by sliding over thestabilizing pins 240 and tightening the arm fixation bolt 236. The armfixation bolt 236 is received in a threaded mounting hole 237 (shown inFIG. 19) that is formed on the upper section of the aiming mount 230.

The aiming mount 230 further comprises a lower section includingopenings 244 for receiving one or more anti-rotation bolts 234 (shown inFIG. 17). The one or more anti-rotation bolts 234 provide additionalrigidity to the aiming mount 230. The lower section includes anotheropening 231 through which the fixation bolt 232 (shown in FIG. 17)extends therethrough. The lower section can further include apositioning feature 239 that guides and orients the aiming mount 230into a proper position relative to the underlying bone plate 10.

FIG. 19 is an alternative side view of a mount of the aiming guide ofFIG. 17. From this view, one can see specific features of the uppersection and lower section of the aiming mount 230. In particular, in theupper section, one can see the plurality of openings 235 for receivingstabilizing pins 240 therein. In addition, one can see the threadedmounting hole 237 that receives the arm fixation bolt 236 to secure theaiming arm 210 to the aiming mount 230. Between the upper section andthe lower section of the aiming mount 230 is an opening 231 forreceiving the fixation bolt 232 therein. From this view, one can see theopenings 244 in the lower section for receiving one or moreanti-rotation bolts 234 therein.

FIG. 20 is a top perspective view of an aiming guide comprising a distalaiming guide and an optional proximal aiming guide in accordance withsome embodiments. The distal aiming guide 210 is capable of guiding oneor more fasteners or screws into distal openings or holes (such as holesor slots 62, 64) of the bone plate 10, while the proximal aiming guide310 is capable of guiding one or more fasteners or screws into proximalopenings or holes (such as rafting holes 32, 34) of the bone plate 10.In some embodiments, both the distal and proximal aiming guides 210, 310are capable of accepting one or more aiming sleeves that interface withdrill guides, trocars, k-wires, and screws. These sleeves can be securedto the respective guide by a ratcheting or clipping mechanism.

The distal aiming guide 210 comprises an arm including a plurality ofguide holes 262 formed therein. The plurality of guide holes 262 aresized and configured to receive one or more aiming sleeves 270 thatinterface with drill guides, trocars, k-wires and screws. In someembodiments, the one or more aiming sleeves 270 help guide screws intoholes or slots 62, 64. The arm includes an extension portion 263 thatincludes one or more additional guide holes 265 for receiving one ormore aiming sleeves 270 therein. The one or more sleeves 270 received inthe one or more guide holes 265 can be used to direct screws orfasteners into one or kickstand holes of the bone plate 10. The distalaiming guide 210 further comprises at least one opening for receiving anattachment post 280 therethrough. The attachment post 280 is configuredto attach to the bone plate 10.

The proximal aiming guide 310 comprises one or more guide holes 362 thatcan be used to direct screws or fasteners into the rafting holes 32, 34of the bone plate 10. In the proximal aiming guide 310, each of theguide holes 362 is formed of a pair of overlapping openings or circles.For example, as shown in FIG. 23, guide hole 362 a is formed of a pairof overlapping openings or circles, as are guide holes 362 b, 362 c, 362d. By providing a pair of overlapping openings or circles, each of theguides holes 362 a, 362 b, 362 c, 362 d can effectively guide one ormore fasteners or screws into a rafting hole in a first row or a secondrow, based on surgeon preference. For example, as shown in FIGS.25A-25D, guide hole 362 a will guide a screw into rafting hole 32 a,guide hole 362 b will guide a screw into rafting hole 32 b, guide hole362 c will guide a screw into rafting hole 32 c, and guide hole 362 dwill guide a screw into rafting hole 32 d. In some embodiments, the dial360 of the proximal aiming guide 310 can assume four different positionsat 20 degrees apart for targeting holes in the underlying plate 10 thatare coaxial with the holes 362 in the guide. In some embodiments, theproximal aiming guide 310 can rotate out of the way to allow for easiervisualization of the plate 10.

In some embodiments, the proximal aiming guide 310 comprises a dial 360that indicates which of the guide holes 362 a, 362 b, 362 c, 362 d willbe available for use. In some embodiments, only a single guide hole 362a, 362 b, 362 c, 362 d will be available in each setting, therebyreducing the risk of confusion to a surgeon. The dial is rotatable andhas a setting that corresponds with each of the guide holes 362, 362 b,362 c, 362 d.

FIG. 21 is a top perspective view of the distal aiming guide of FIG. 20.As shown in the figure, the distal aiming guide 210 comprises an armhaving a plurality of guide holes 262 extending along a length of thearm. The guide holes 262 correspond to one or more holes or slots in thebone plate 10, thereby allowing a screw to be easily guided into aproper position on the plate. In some embodiments, the guide holes 262are coaxial with holes or slots in the bone plate 10. In someembodiments, the guide holes 262 accept a guide (e.g., a sleeve) indifferent positions to target non-locking plate holes in either a staticor eccentric position. This facilitates percutaneous insertion ofnon-locking screws either statically or for dynamic compression. In someembodiments, the distal aiming guide 210 includes guide holes 262 thatcorrespond with holes or slots in the shaft portion 26 of the bone plate10, as well as guide holes 265 that correspond with kickstand holes inthe neck portion 24. In some embodiments, the guide holes 262 thatcorrespond with holes or slots in the shaft portion 26 accepts only onetype of aiming sleeve 270, while the guides holes 265 that correspondwith the kickstand holes in the neck portion 26 accept another type ofaiming sleeve 270. In some embodiments, the distal aiming guide 210 canbe formed of a radiolucent material to prevent obstruction offluoroscopic imaging while in an operating room.

The distal aiming guide 210 includes a pair of attachment arms 267, 269.The first attachment arm 267 comprises a first connection 281 a and thesecond connection arm 269 comprises a second connection 281 b. Each ofthese connections 281 a, 281 b is capable of attachment to an optionalproximal aiming guide 310. By providing two connections 281 a, 281 b,the distal aiming guide 210 is advantageously reversible such that it iscan be acceptably used via left hand or right hand.

FIG. 22 is a bottom perspective view of an attachment post in accordancewith some embodiments. The attachment post 280 is insertable through aconnection opening 381 in the proximal aiming guide 310 (shown in FIG.20), as well as through a connection 281 (shown in FIG. 21) in thedistal aiming guide 210 (shown in FIG. 21). The attachment post 280 isconfigured to engage an underlying bone plate 10. The attachment post280 comprises one or more ball-end pins 282 for engaging alignmentindentations 44 (shown in FIG. 1) of the bone plate 10. In addition, theattachment post 280 comprises a threaded shaft 284 for threadinglyattaching to an instrument attachment hole 44 in the bone plate 10. Theattachment post 280 further comprises a stabilizing feature 287 thatassists with alignment during attachment.

FIG. 23 is a top perspective view of the proximal aiming guide of FIG.20. From this view, one can see the guide holes 362 a, 362 b, 362 c, 362d, as well as the dial 360 that determines which of the guide holes 362a, 362 b, 362 c, 362 d is available for use. In addition, FIG. 23 showsneighboring guide holes 392 through which one or more additional aimingsleeves can be inserted. In addition, a connection opening 381 is shownthrough which an attachment post 280 can be received therein. In someembodiments, the connection opening 381 in the proximal aiming guide 310is coaxial with a connection 281 in the distal aiming guide 210, suchthat the attachment post 280 can extend through both the proximal aimingguide 310 and the distal aiming guide 210.

FIG. 24 is a top perspective view of the distal aiming guide withproximal aiming guide of FIG. 20. From this view, one can see how theattachment post 280 extends through the connection opening 381 of theproximal aiming guide 310 and into the connection 281 in the distalaiming guide 210 before engaging the bone plate 10. The attachment post280 advantageously serves as a means to secure the distal aiming guide210 with the proximal aiming guide 310.

FIG. 25A is a view of the distal aiming guide with proximal aiming guidein a first setting. In this first setting of the dial 360, the aimingsleeve 270 is capable of being inserted into guide hole 362 a.

FIG. 25B is a view of the distal aiming guide with proximal aiming guidein a second setting. In this second setting of the dial 360, the aimingsleeve 270 is capable of being inserted into guide hole 362 b.

FIG. 25C is a view of the distal aiming guide with proximal aiming guidein a third setting. In this third setting of the dial 360, the aimingsleeve 270 is capable of being inserted into guide hole 362 c.

FIG. 25D is a view of the distal aiming guide with proximal aiming guidein a fourth setting. In this fourth setting of the dial 360, the aimingsleeve 270 is capable of being inserted into guide hole 362 d.

FIG. 26 is a cross-sectional view of a dial in the proximal aimingguide. FIG. 27 is a top perspective view of dial in the proximal aimingguide. The dial 360 comprises a rotating mechanism that uses a variationof a Hirth coupling 382 and a spring 384 that accommodates differentsettings. As the dial 360 is rotated by hand, the top coupling 382 a ofthe Hirth coupling 382 exerts a force on the bottom coupling 382 bcausing it to translate axially along a shaft. Once clearance isachieved, the dial 360 will complete its designed rotation (e.g., 20degrees) with a click. The retention cap 387 holds the dial 360 in placeaxially along the shaft and counteracts the force of the spring 384which forces the bottom coupling 382 b to translate down with therotation.

As noted above, embodiments of the bone plates can include one or morerows of rafting openings or holes for receiving rafting screws therein.These rafting screws can be provided at or near an articular joint of abone, thereby reducing the risk of subsidence at the articular joint.More details regarding the rafting screws, as well the optional use ofnon-threaded rafting blades, are provided below.

FIG. 46 is a diagram showing an alternate embodiment of an aiming guideaccording to one embodiment of the present invention. In the illustratedembodiment, the aiming guide 452 may be operatively connected to anunderlying plate 10, and includes an attachment post 454 and a threadedshaft 456. The aiming guide 452 illustrated in FIG. 46 and itsindividual components are similar to the aiming guide 200 described withrespect to FIGS. 17-22 above, with some modifications. The modificationsto the aiming guide 200 will be described in turn below.

FIG. 47 is a diagram showing a detailed view of the aiming guide 452according to one embodiment of the present invention. The embodiment ofthe aiming guide 452 shown in FIG. 47 may provide one advantage ofallowing a single rigid connection between the aiming guide 452 and thebone plate 10, as described in more detail below. When the rigidconnection is in place, the corresponding holes 262 of the aiming arm458 and the holes 62 of the bone plate 10 are coaxial. In theillustrated embodiment, the aiming guide 452 includes an aiming arm 458and an attachment guide 460. The aiming arm 458 is substantially similarto the aiming arm 210 described with respect to FIG. 17, and includesone or more guide holes 262 that help guide one or more fasteners,screws, or other instruments into the corresponding holes 62 of theplate 10 with accuracy. In contrast to the FIG. 17 embodiment, theaiming guide 452 of the FIG. 46-47 embodiment, does not include anaiming mount 230. Instead, the aiming guide 452 includes an attachmentguide 460 that is configured and dimensioned to extend from a portion ofthe aiming arm 458.

In one embodiment, the attachment guide 460 may extend from one side 459of the aiming arm 458, as shown in FIG. 47. The attachment guide 460 maybe positioned such that it is near one end, e.g., the distal 461 orproximal end 463, of the aiming arm 458. In some embodiments, it may bedesirable for the attachment guide 460 to comprise an arm that extendsfrom the aiming arm 458, as shown in FIG. 47. At least a portion of theattachment guide 460 may be configured and dimensioned to be angled suchthat it can guide the attachment post 454 into the instrument attachmenthole 44 in the bone plate 10. Alternately, the attachment hole 462itself, through which the attachment post 454 passes, may be configuredand dimensioned to include an angle that allows the attachment post 454to be guided into the instrument attachment hole 44. In such anembodiment, the attachment guide 460 may be angled and may lie in thesame plane as the aiming arm 458. In other embodiments, both theattachment guide 460 and the attachment hole 462 may be configured anddimensioned to include angles. Alternately, the attachment guide 460 maybe configured and dimensioned such that the attachment hole 462 iscoaxial with a hole in the neck portion of the bone plate 10, such asthe instrument attachment hole 44.

The aiming guide 452, according to one embodiment, may include “left” or“right” configurations to assist with guiding the insertion of screws orother instruments through plates 10 of various configurations. In a leftconfiguration, shown in FIG. 47, the attachment guide 460 is configuredand dimensioned as an arm that extends from one side 459 of the aimingarm 458. Although a left configuration is shown in FIGS. 46-47, a rightconfiguration may comprise an attachment guide 460 that extends from theopposite side 465 of the aiming arm 458. In some embodiments, both a“left” and a “right” configuration may be included if desired, i.e.,both a left and right arm may be attached to the aiming arm 458, withone extending from a first side 459 and another extending from theopposite side 465.

The attachment guide 460 includes an attachment hole 462 through whichthe attachment post 454 may pass. In one embodiment, the attachment hole462 also allows the attachment post 454 to be operatively connected tothe attachment guide 460. Other holes may also be configured anddimensioned in the attachment guide 460, such as kickstand targetingholes 464. The kickstand targeting holes 464 may allow one or moreinstruments to pass through to engage with kickstand holes 52, 62 in thebone plate 10, as described above.

FIGS. 48A-48C show one embodiment of the attachment post 454 andthreaded shaft 456 in more detail. The threaded shaft 456 shown in FIG.48A is substantially similar to the threaded shaft 284 described above.FIG. 48B shows a bottom perspective view of an attachment post 454 inaccordance with one embodiment. The attachment post 454 is substantiallysimilar to the attachment post 280 described with respect to FIG. 22above.

In this embodiment, the attachment post 454 is configured to engage anunderlying bone plate 10. The attachment post 454 also includes one ormore ball-end pins 282 for engaging alignment indentations 44 (shown inFIG. 1) of the bone plate 10. In addition, the attachment post 454includes a threaded opening operable to receive the threaded shaft 456for threadingly attaching to an instrument attachment hole 44 in thebone plate 10. In other embodiments, at least a portion of the openingin the attachment post 454 may not be threaded, which provides theadvantage of allowing the attachment post 454 to slide over the threadedshaft 456. The attachment post 454 further comprises a stabilizingfeature 287 that assists with alignment during attachment.

The bottom surface of the attachment post 454 may be offset andcontoured to match the contour of the bone plate 10 at the attachmentlocation. The attachment post 454 may be operatively connected to thebone plate 10 using a nut threading onto the threaded shaft 456. Inaddition, at least a portion of the outer surface of the attachment post454 may be threaded so that it can be attached to the attachment guide460 using the attachment hole 462. In this embodiment, the end of theattachment post 454 distal from the end attached to the bone plate 10may be threaded and may be operatively connectable to correspondingthreading on the inner surface of the attachment hole 462.

As shown in FIG. 48C, an upper portion 467 of the attachment post 454may include a lip 466 that is configured and dimensioned along its upperend, distal from the end that is attached to the bone plate 10. Theupper portion 467 of the attachment post 454 may also be tapered suchthat it results in an interference fit with the attachment hole 462. Theattachment post 454 may be secured to the attachment guide 460 using anarm attachment nut 468, as shown in FIG. 48C. A post attachment nut 470may also be included to secure the attachment post 454 to the armattachment nut 468, the threaded shaft 456, or both.

As described above, the aiming guide 452 includes one or more guideholes 262 that help guide one or more fasteners, screws, or otherinstruments into the corresponding holes 62 of the plate 10 withaccuracy. In one embodiment, the guide holes 262 of the aiming guide 452may accept one or more tissue protection sleeves 472. The tissueprotection sleeves 472 provide a portal into small incisions throughwhich various instruments may pass. Examples of instruments that maypass through the tissue protection sleeves 472 include, but are notlimited to, trocars 496, drill sleeves 488, DCP sleeves 492, drills 490,drivers, screws, and the like. The tissue protection sleeves 472 mayoperatively connect to the guide holes 262 in a desired orientation.When operatively connected to the guide holes 262, the tissue protectionsleeves 472 allow an accurate and rigid interface with the aiming guide452.

FIGS. 49A-49B are diagrams showing exemplary tissue protection sleevesaccording to one embodiment of the present invention. The tissueprotection sleeve 472 may be inserted through a guide hole 262 and thenoperatively connected thereto. As shown in FIG. 49A, one embodiment ofthe tissue protection sleeve 472 may include a head 474 and a tip 476.The tip 476 may be configured and dimensioned to fit into the holes 62of the bone plate 10. The head 474 may comprise a relief cut 478 and aretention ledge 480. The relief cut 478 is configured and dimensionedsuch that a portion of the head 474 comprises a movable arm 482 that canflex between an open (expanded) and closed (compressed) position. Themovable arm 482 is operable to flex about a pivot point at the bottom ofthe relief cut 478, as shown best in FIG. 49B. The movable arm 482 mayalso include a retention ledge 480 on its outer surface.

The guide holes 262, according to one embodiment, may be configured anddimensioned to include complementary features that interact with thehead 474 of the tissue protection sleeve 472. In this embodiment, eachguide hole 262 may include a recess 484 in a top portion of the hole262. The recess 484 is configured and dimensioned to allow a bottomportion of the head 474 to sit inside the guide hole 262. A portion ofthe hole 262 may also include an undercut 486 that is operable tointeract with the retention ledge 480 configured on the movable arm 482.The undercut 486 may be configured and dimensioned to house theretention ledge 480 when the movable arm 482 is in its steady-state,expanded configuration, as shown in FIG. 49B. Similarly, the retentionledge 480 may be configured and dimensioned to fit within the undercut486 in its steady-state, expanded configuration. The retention ledge 480is also configured and dimensioned such that it can move axially withinthe hole 262 when the movable arm 482 is compressed towards the head474.

When the tissue protection sleeve 472 is inserted into the hole, thehead 474 rests inside the recess 484, according to one embodiment.During insertion, the movable arm 482 is compressed towards the head474, allowing the retention ledge 480 to pass into the hole 262. Whenthe head 474 fully rests inside the recess 484, the retention ledge 480is positioned below the undercut 486, allowing the arm 482 to expandinto its steady-state, expanded position, as shown in FIG. 49B. Wheninserted in this manner, tactile feedback or an audible sound, e.g., aclick, may be felt or heard as the retention ledge 480 grabs theundercut 486. In order to release the tissue protection sleeve 472, thearm 482 may be compressed towards the head 474, allowing the retentionledge 480 to be removed from the undercut 486. With the retention ledge480 no longer operatively connected to the undercut 486 and restrictedfrom axial movement, it may be moved out of the hole 262.

As discussed above, a tissue protection sleeve 472 provides a portalinto small incisions through which various instruments may pass. FIG. 50is a diagram showing exemplary instruments passing through tissueprotection sleeves 472 that have been inserted into the guide holes 262of the aiming arm 458. A drill sleeve 488, for example, may be insertedinto the tissue protection sleeve 472 and operatively connected to thebone plate 10. In one embodiment, the drill sleeve 488 aligns a drill490 to a center axis of the hole 262. Alternatively, a DCP sleeve 492may be inserted to allow off-axis insertion of a drill 490. Oneadvantage of using an off-axis sleeve is that it allows for off-axispredrilling that can set up compression through a DCP hole that isoffset in either direction. For instance, a DCP sleeve 492 may allowcompression of 1 mm through a DCP hole in either direction.

In other embodiments, a hole marker 494 may also be inserted into a hole262 in the aiming arm 458 to allow for marking of a hole. This may beadvantageous, for example, to allow for marking of the last hole 262used, or to indicate a hole which has already been filled with a device,such as a screw. Still other embodiments may allow for other devices,such as a round-tip trocar 496, to be inserted into the tissueprotection sleeve 472. Those skilled in the art will understand that oneor more tissue protection sleeves 472 and corresponding devices may beusing in combination with the present invention as desired. AlthoughFIG. 50 illustrates multiple tissue protection sleeves 472 and devicesinserted into the aiming arm 458 at the same time, this is done forillustrative purposes only. One or more sleeves 472 and/or other devicesmay be used at one time if desired. In other embodiments, only onesleeve 472 and/or device maybe used at one time.

According to one embodiment, the aiming guide 452 attaches to the boneplate 10 using a single attachment post 454 and the threaded shaft 456.As described above, the attachment post 454 is aligned to the bone plate10 based on the ball-end pins 282 and the stabilizing feature 287.According to one embodiment, the threaded shaft 456 is assembled ontothe plate 10 first. The attachment post 454 may then slide over thethreaded shaft, and the ball-end pins 282 align with alignmentindentations 44 in the bone plate 10. The stabilizing feature 287assists with alignment during attachment of the attachment post 454. Theattachment post 454 is then operatively connected to the bone plate 10using a nut threading onto the threaded shaft 456. In this manner, theattachment post 454 may be rigidly fixed to the bone plate 10 and may beused as an insertion handle. The attachment guide 460 slides over top ofthe attachment post 454 and is fastened into place with the armattachment nut 468. A post attachment nut 470 may be optionally used tooperatively connect the attachment guide 460 to at least one of theattachment post 454, the arm attachment nut 468, and/or the threadedshaft 456.

According to one embodiment, the aiming arm 452 may comprise aradiolucent material in order to prevent the obstruction of lateralimaging during a medical procedure. The “left” and “right”configurations allow for guiding insertion of screws, fasteners, orother devices through either side of a bone plate 10. The associatedtissue protection sleeves 472, drill sleeves 488, and otherinstrumentation described herein may be used with the aiming guide 452in both the left and right configurations.

In one embodiment, the aiming guide 452 may also be used with a proximalaiming guide 498. In this embodiment, the proximal aiming guide 498comprises a plate that may be operatively connected to the bone plate 10separately from the aiming guide 452. The proximal aiming guide 498 maybe used with or without the aiming guide 452. FIG. 51A is a topperspective view of the proximal aiming guide 452. The proximal aimingguide 452 includes one or more guide holes 500.

In one embodiment, the proximal aiming guide 452 includes a fasteningmechanism that allows it to be operatively connected to the bone plate10. For example, the proximal aiming guide 452 may include clips 502that are configured and dimensioned to allow the guide 452 to beoperatively connected to the bone plate 10. In one embodiment, the clips502 may be formed as a part of the proximal aiming guide 452.Alternately, the clips 502 can be separate elements. In otherembodiments, clips 502 maybe formed as a part of the bone plate 10. Theclips 502 may be positioned near one or more edges of the proximalaiming guide 452 in order to secure it to the bone plate, as shown inFIG. 51A.

The proximal aiming guide 498 may also include openings 504 that areselectively positioned in one or more different locations. The openings504 may be configured and dimensioned near the perimeter of the proximalaiming guide 498, as shown in FIG. 51A, in order to guide the proximalaiming guide 498 into the correct placement on the bone plate 10. Theopenings 504 may be configured to receive protrusions, such as pegs 506,that facilitate the alignment of the guide holes 500 and thecorresponding holes in the bone plate 10. In this embodiment, the pegs506 may be configured and dimensioned as part of the bone plate 10. Inanother embodiment, the bone plate 10 may include openings through whichpegs that protrude from the proximal aiming guide 498 may pass in orderto facilitate alignment of the guide holes 500 and the correspondingholes 62 in the bone plate 10.

FIG. 51B is a diagram showing another top perspective view of theproximal aiming guide 498. When the proximal aiming guide 498 isoperatively connected to the bone plate 10, it allows for the insertionof tools, such as drill sleeves 508, through the guide holes 500, asshown in FIG. 51B. The insertion of drill sleeves 508 allows for thetargeting of the nominal angle of the proximal holes in the bone plate10. After drilling, the drill sleeve 508 may be removed and a screw orother fastener may be inserted through the proximal aiming guide 498.When all fasteners, e.g., screws, have been placed, the proximal aimingguide 498 may be removed. Removal of the proximal aiming guide 498 maybe accomplished by hand, or by using a tool such as a drill sleeve topry it off of the bone plate 10.

FIG. 28 is a front view of a bone plate including rafting screwsattached to a bone member. The bone plate 10 can be any of the boneplates described above and can include fasteners or screws 6 extendingtherethrough. As shown in the figure, the upper row of screws 6 can beconsidered rafting screws. These rafting screws not only help to treat abone fracture, but they have to prevent subsidence near the articularjoint.

FIG. 29 is a side view of the bone plate of FIG. 28. From this view, onecan see the rafting screws extending across a fracture in the bone. Therafting screws are positioned adjacent to the articular joint to preventsubsidence near the articular joint.

FIG. 30 is a top view of the bone plate of FIG. 28. From this view, onecan see how the rafting screws serve as rebar and provide support forthe articular joint.

In addition to these rafting screws, which are threaded, non-threadingrafting blades can be provided. In some embodiments, these non-threadedblades help to (i) provide better support of an articular surface, (ii)minimize time in surgery due to ease of insertion; and (iii) have areduced risk of post-operative back out.

FIG. 31 is a top perspective view of a rafting blade in accordance withsome embodiments. The rafting blade 406 can be used in addition to, oras an alternative to, the threaded rafting screws described previously.In some embodiments, one or more rafting blades 406 can be insertedthrough a bone plate that has been secured to bone via one or morefasteners or screws. The one or more blades can then be locked to thebone plate to prevent post-operative back out.

The rafting blade 406 comprises a proximal end 412 and a distal cuttingend 414. The distal cutting end 414 advantageously enables the raftingblade 406 to be inserted into bone with ease, simply by impacting theproximal end 412 of the rafting blade 406. In some embodiments, therafting blade 406 is curved or arced. In some embodiments, the raftingblade 406 is concave, thereby forming a concave rafting surface. In someembodiments, the rafting blade 406 comprises a structural rib 422 thatextends along a longitudinal axis of the rafting blade 406. Thestructural rib 422 and concave rafting surface advantageously improvethe bending moment along the length of the rafting blade 406, therebyproviding support against failure during and after insertion.

FIG. 32 is a top view of the rafting blade of FIG. 31. From this view,one can see how the structural rib 406 extends along a centrallongitudinal axis of the rafting blade 406. In some embodiments, thestructural rib 406 extends along a majority of the length of the centrallongitudinal axis of the rafting blade 406.

FIG. 33 is a side view of the rafting blade of FIG. 31. From this view,one can see the concave curvature of the rafting blade 406.

FIG. 34 is a side view of a pair of rafting blades attached to a platein accordance with some embodiments. The plate 10 comprises a curved ordomed plate contact surface that facilitates rotation in one planeallowing the rafting blades 406 to be inserted parallel to an articularsurface regardless of plate position. In some embodiments, raftingblades 406 can be inserted at a similar angle to one another. In otherembodiments, rafting blades 406 can be inserted at different angles fromone another.

FIG. 35A is a front view of the rafting blade of FIG. 31. From thisview, one can see how the rafting blade 406 comprises a k-wire hole 430.The rafting blade 406 can be cannulated to allow guided insertion byk-wire. In some embodiments, the rafting blade 406 can be tapped intobone via use of a slotted hammer.

FIG. 35B is a bottom perspective view of the rafting blade of FIG. 31.From this view, one can see the underside of the rafting blade 406 andits cannulated k-wire hole 430.

FIG. 36 is a top perspective view of an insertion guide for raftingblades in accordance with some embodiments. FIGS. 37A and 37B is ainsertion guide detached from the rafting blades of FIG. 36. Theinsertion guide 500 allows for a set of parallel or variable angledrafting blades 406 to be inserted simultaneously into a bone member. Inother embodiments, a rafting blade can be individually installed. Byaccommodating a set of rafting blades, the insertion guide 500advantageously reduces the time in surgery. In some embodiments, theinsertion guide 500 comprises a block that can temporarily engage orattach to a bone plate after the bone plate has been secured to bone.The block can include a series of channels or openings through which therafting blades 406 can be inserted therein. In some embodiments, aplurality of rafting blades 406 are preloaded into the insertion guide500. In other embodiments, the insertion guide 500 can be used withoutpreloading rafting blades 406, thereby allowing a surgeon to selectlengths that best suit a particular patient. With the insertion guide500 in place, the rafting blades 406 can be tapped into bone insequence. As shown in FIG. 36, in some embodiments, three rafting blades406 can be inserted in the insertion guide 500. In some embodiments, themiddle blade can be shaped in such a way to prevent back out of theother two rafting blades, as shown in FIGS. 38A and 38B.

FIGS. 38A and 38B is rafting blades following insertion in accordancewith some embodiments. Three rafting blades 406 are provided in theinsertion guide 500. The blades 406 include first blade 406 a, secondblade 406 b, and third blade 406 c. The blades 406 are tapped in aparticular sequence such that the third blade 406 c prevents backout ofthe first and second blades 406 a, 406 b. In particular, by tappingfirst blade 406 a and second blade 406 b prior to tapping the thirdblade 406 c, the third blade 406 c can be sized and configured (e.g.,via its proximal head portion) to prevent inadvertent backout of thefirst blade 406 a and the second blade 406 b.

FIG. 39 is a top perspective view of rafting blades and an independentsupport screw in accordance with some embodiments. In the presentembodiment, rafting blades 406 that are inserted into a bone plate 10through rafting holes 432 are accompanied by a support screw 506. Thesupport screw 506 advantageously supports the tips of the rafting blades406 after insertion.

FIG. 40A is a front view of a blocking mechanism for the rafting bladesin accordance with some embodiments. FIG. 40B is a front view of theblocking mechanism of FIG. 40A rotated. In some embodiments, theblocking mechanism 520 comprises a blocking screw. In some embodiments,the blocking mechanism 520 comprises a rotating member that allowsinsertion of rafting blades 406 in one configuration, but prevents therafting blades 406 from backing out in another rotated configuration. Inthe embodiment in FIG. 38, in which a middle rafting blade 406 cprevents backout of adjacent rafting blades 406 a, 406 b, the blockingmechanism 520 can simply be installed behind the middle rafting blade406.

FIG. 41 is a side view of a rafting blade and locking cap in accordancewith some embodiments. The locking cap advantageously prevents therafting blade from toggling within a bone plate and keeps it within thebone plate. In some embodiments, a locking cap 440 can be used tocollapse over a spherical head 410 of a rafting blade 406. The outsideof the locking cap 440 can have a conical surface with cutouts 442around its diameter. In some embodiments, the cutouts 442 are zig-zaggedor z-shaped. In other embodiments, the cutouts 442 are slits. The insideof the locking cap 440 can be spherical to allow the variable angleinstallation of a rafting blade 406. The locking cap 440 can bethreaded. As the locking cap 440 is threaded into a bone plate, itsconical geometry and cutouts 442 allow it to collapse over the sphericalhead 410, grip to the grooved surface of the spherical head 410 and lockit into plate within a bone plate.

FIG. 42 is a top perspective view of the rafting blade attached to thelocking cap of FIG. 41. From this view, one can see how the head of therafting blade 406 is received in the locking cap 440.

FIG. 43 is a top perspective view of the locking cap of FIG. 41. Fromthis view, one can see the inner portion of the threaded locking cap440. In addition, one can see how the cutouts 442 are formed around aperimeter of the locking cap 440. As shown in FIG. 43, cutouts 442 canbe initiated at a top or bottom section of the locking cap 440.

FIG. 44 is a top perspective view of a rafting blade having deformingridges in accordance with some embodiments. FIG. 45 is a bottomperspective view of the rafting blade having deforming ridges of FIG.44. In some embodiments, the rafting blade 406 can comprises one or moreridges 450 where it contacts a bone plate. These one or more ridges 450can cause a small amount of deformation in the bone plate as the boneplate is inserted, which would advantageously help to lock the raftingblade 406 in place. As shown in FIG. 44, the rafting blade 406 cancomprise a pair of ridges 450, each of which is off-center from alongitudinal axis of the rafting blade 406.

According to one aspect of the present invention, a radiolucent panelwith radiopaque anatomic and/or mechanical references is included. Theradiolucent panel may be used, for example, to assist with theintraoperative restoration of normal femoral and tibial anatomy underfluoroscopy in the operating room. As used herein, each angle ismeasured relative to a mechanical (m) or anatomic (a) axis. The anglemay be measured medial (M), lateral (L), anterior (A), or posterior (P)to the axis line. In addition, the angle may refer to the proximal (P)or distal (D) joint orientation angle of either the femur (F) or tibia(T). For example, mLDFA as used herein refers to the mechanical lateraldistal femoral angle in the frontal plane and the PPTA refers to theposterior proximal tibia angle in the sagittal plane. Additionally, theJLCA is the joint line congruency angle referring to the angle betweenthe distal femur and the proximal tibia. The ANSA and MNAS are theanterior and medial neck shaft angles, respectively, which measure theangle between the center of the femoral neck and the proximal femoralshaft.

According to one embodiment, the present invention includes a guide thatcomprises a panel with one or more references. The references mayinclude, but are not limited to, lines, points, rulers, letters, dashes,pictures, shapes, arrows, and the like. For instance, any medicalreference may be included, including those known to medicalprofessionals, e.g., surgeons or the like. In one embodiment, anatomicand mechanical axis lines may be included, for example. The exemplaryguide may also include a ruler for measurements during a medicalprocedure. Any units of measurement may be used for the ruler, includingthe metric or U.S. system of measurement. The ruler may be used tomeasure the length of body parts, such as limbs, or alternately may beused to measure medical devices for insertion or as a frame of referencefor placement of screws, fasteners, trauma treatment instruments andimplants, including external fixators, ring fixators, rods, and otherplates.

It may be desirable and advantageous for one embodiment of the guide tobe used during medical procedures, such as intraoperative procedures. Assuch, one embodiment of the guide comprises a radiolucent panel. Anyradiolucent material known to those skilled in the art may be usedincluding, but not limited to, plastic, carbon, fibers, composites, andcombinations thereof. In some embodiments, it may be desirable for thereferences included in the guide to be formed from one or moreradiopaque materials. In such embodiments, at least one of thereferences may comprise metallic wire or radiopaque ink, for example.References such as anatomic and/or mechanical axis lines may alsoinclude metallic wire or radiopaque ink in some embodiments.

In such embodiments, the metallic wire or radiopaque ink may bepositioned on an inner or outer surface of the guide. Alternately, themetallic wire or radiopaque ink may be formed as a part of the guide. Itmay desirable in other embodiments for the metallic wire or radiopaqueink to be formed between layers of the guide, i.e., if the guide isformed of two or more layers, the metallic wire or radiopaque ink may bepositioned in between the two or more layers. When the guide is formedof two or more layers, it may be desirable to include ink on an inner orouter surface of one or more of the layers.

As discussed above, the guide may comprise a panel in one embodiment.The shape and dimensions of the panel may be varied as desired for aparticular application. For instance, one embodiment of the guide 510may comprise a single rectangular panel having a length that is greaterin magnitude than its width, as shown in FIG. 52. One embodiment of theguide 510 may comprise a single, reversible guide that has referencesfor left limbs on one side and right limbs on the other side.Alternately, the guide 510 may be one sided and have separate guides forleft limbs and right limbs.

FIG. 52 shows one exemplary embodiment of a guide according to oneembodiment, as discussed above. As shown in the figure, the guide 510may comprise a panel that is reversible. In this embodiment, the guide510 may include a side reference 511 that indicates the properorientation for which side of the body it is to be used with. In theFIG. 52 embodiment, the guide 510 on the left (in the figure) may beused with limbs on the left side of a person's body, while the guide 510on the right (in the figure) may be used with limbs on the right side ofa person's body. The proper orientation is evident when the “left” or“right” side reference 511 is legible.

The references included on the guide 510 may also include anatomic andmechanical axis lines 512, as shown in FIG. 52. The references mayinclude a ruler 514. As shown in the FIG. 52 embodiment, the ruler maybe positioned along the perimeter of the guide 510.

FIG. 53 is a diagram showing a more detailed view of a frontal plane(AP) guide mechanical and anatomic reference angles according to oneembodiment. According to one embodiment, the guide 510 may includeseveral mechanical and anatomic axis lines 512 or other indicators forcomparison to adjacent anatomy. For example, the reference lines 512 maybe at their nominal normal values for comparison to the anatomy shown ona fluoroscopic image. Although the guide 510 may include reference textlabeling of the axes in angles in some embodiments, reference textlabeling may not be included in other embodiments.

As best seen in FIG. 65, the mechanical and anatomic reference lines 512or any other indicators may be in the form of ink, wires, or the like.For example, the lines 512 may be made of one or more metallic wires,metallic ink, or other radiopaque materials configured to be visible onfluoroscopy or other imaging during a surgical procedure. The guide 510may comprise a first rectangular panel 510 a and a second rectangularpanel 510 b, for example, formed of a radiolucent material, comprisingdimensions substantially similar to one another. The wires, ink, orother reference markers may be positioned in between the first andsecond rectangular panels 510 a, 510 b and the first and secondrectangular panels 510 a, 510 b may be operatively connected to oneanother, for example, by adhesive, melting the panels together, or othersuitable means. For example, the wires, ink, or other reference markersmay be positioned on one of the panels 510 a, 510 b before sandwichingthem together.

The exemplary guide 510 shown in FIG. 53 may be of assistance with, forexample, aligning the knee joint, the proximal and distal femur, thefemoral neck, and the proximal and distal tibia. The guide 510 may alsoenable limb length measurement during repair of a fractured limb bycomparison to the contralateral anatomy. As shown in FIG. 53, the guide510 may include various references that allow for the determination ofmechanical or anatomical angles.

As shown in FIG. 53, one embodiment may include reference lines 512 thatallow for the determination of the medial neck shaft angle (MNSA) 516,which may be a comparison between two overlapping reference lines 512.The MNSA may be between about 124 degrees to about 136 degrees, or about130 degrees. In addition, guide 510 may include reference lines 512 thatallow for the determination of the anterior medial proximal angle(aMPFA) 518, which may be between about 80 degrees and about 89 degrees,or about 84 degrees. Reference lines 512 may also allow for thedetermination of the joint line congruency angle (JLCA) 520, which maybe between about 0 degrees and about 2 degrees, or about 1 degree. Themedial proximal tibial angle (MPTA) 522 may also be measured using thereferences 512 included in the guide 510. The MPTA 522 may be betweenabout 85 degrees and about 90 degrees, or about 87 degrees, as shown inFIG. 53.

The guide 500 may include any number of references or indicators. Inother embodiments, the guide 510 may include reference lines 512 thatallow the mechanical lateral proximal femoral angle (mLPFA) 524 to bemeasured. The mLPFA 524 may range between about 85 degrees and about 95degrees, or about 90 degrees, for example. The mechanical lateral distalfemoral angle (mLDFA) 526 may also be measured using reference lines 512included in the guide 510, and may range between about 85 degrees andabout 90 degrees, or about 88 degrees. Reference lines 512 may also beincluded to measure the anatomic lateral distal femoral angle (aLDFA)528, which may range between about 79 degrees and about 83 degrees, orabout 81 degrees. One embodiment of the guide 510 also allows for themeasurement of the lateral distal tibial angle (LDTA) 530, which mayrange between about 86 degrees and about 92 degrees, or about 89degrees.

FIGS. 54-57 are diagrams showing examples of the guide 510 being used tomeasure anatomic angles during interoperative use. FIG. 54, for example,shows how the guide 510 can be used during intraoperative use to measurethe knee joint, distal femur, and proximal tibia alignment. FIG. 55 is adiagram that shows how the guide 510 may be used during intraoperativeuse to measure the proximal femur and femoral neck alignment. FIG. 56 isa diagram that shows how the guide 510 may be used during intraoperativeuse to measure the distal tibia alignment. FIG. 57 is a diagram thatshows how the guide 510 may be used during intraoperative use to performa limb length comparison using the ruler 514.

During surgical procedures, it is sometimes desirable to obtain lateralimages. FIG. 58 is a diagram showing another embodiment of guide 510according to one aspect of the present invention. One embodiment of theguide 510 shown in FIG. 58 comprises a sagittal plane guide that mayassist with lateral imaging. The guide 510 comprises similar materialsto the guide described with respect to FIGS. 52-58 above. In contrast tothe embodiments described in FIGS. 52-58, the references may comprisemechanical and anatomic axes at their nominal normal angles for thesagittal plane. The references may also include text labeling the axesand angles, as described above. The FIG. 58 embodiment of guide 510 maybe used, for example, to align the knee joint, the proximal and distalfemur, the femoral neck, and the proximal and distal tibia.

As shown in FIG. 58, the guide 510 may include references that allow forthe measurement of various anatomic angles. For example, reference lines512 may be included that allow the anterior neck shaft angle (ANSA) 532to be measured, and may range between about 165 degrees and about 175degrees, or about 170 degrees. In addition, reference lines 512 may beincluded that allow the anterior distal tibial angle (ADTA) 534 to bemeasured, and may range between about 78 degrees and about 82 degrees,or about 80 degrees. In some embodiments, reference lines 512 may beincluded that allow the posterior proximal femoral angle (PPFA) 536 tobe measured, and may range between about 88 degrees and about 92degrees, or about 90 degrees. Reference lines 512 may also be includedthat allow the posterior distal femoral angle (PDFA) 538 to be measured,which may range between about 79 degrees and about 87 degrees, or about83 degrees. Additionally, reference lines 512 may be included that allowthe posterior proximal tibia angle (PPTA) 540 to be measured, which mayrange between about 77 degrees and about 84 degrees, or about 81degrees.

FIGS. 59-60 are diagrams showing the guide 510 of FIG. 58 duringintraoperative use. FIG. 59, for example, is a diagram that shows theguide 510 being used to evaluate the proximal femur and femoral neckalignment. FIG. 60 is a diagram that shows the guide 510 being used toevaluate the distal tibia alignment.

In some embodiments, the guide 510 may include reference linesindicating the normal limits of the mechanical and anatomic axes. FIG.61 is a diagram showing a guide 510 that includes dotted reference lines542 indicating the limits of each mechanical and anatomic axis 512. Theguide 510 on the left of FIG. 61 is an exemplary frontal guide and theguide 510 on the right of FIG. 61 is an exemplary sagittal guide thatinclude dotted reference lines 542.

In various embodiments, the guides 510 may come packaged together or aspart of a kit. In one embodiment, a sagittal and frontal guide may beformed as a single, foldable element, as shown in FIG. 62A. Inembodiments where the guides 510 are foldable, the sagittal guide may bepositioned at an angle, e.g., a 90 degree angle, to the frontal guideusing a support, such as a bracket or the like (not shown) in FIG. 62A.One advantage of including a support is that it would facilitate holdingthe guides 510 in place during imaging, such as lateral fluoroscopicimaging. In other embodiments, such as the embodiment shown in FIG. 62B,the frontal and sagittal guides may be positioned adjacent to oneanother.

In one embodiment, it may be desirable for the guides 510 to besterilized and packaged. The guides 510 may comprise various shapes anddimensions, and may be packaged together with guides 510 of similarshapes and dimensions or with guides 510 of varying shapes anddimensions. The guides 510 may be configured and dimensioned indifferent sizes to fit into different cases 546 as a reusable guide 510,as illustrated in FIG. 64. To aid with sterilization, the guides 510 mayinclude one or more perforations 544, as shown in FIG. 63. Theperforations 544 may provide the advantage of allowing sterilization,e.g., steam sterilization, for example, in a graphic case.

One skilled in the art will appreciate that the embodiments discussedabove are non-limiting. While bone plates may be described as suitablefor a particular approach (e.g., medial or lateral), one skilled in theart will appreciate that the bone plates can be used for multipleapproaches. In addition, while bone plates are described as havingparticular holes (e.g., locking or non-locking), one skilled in the artwill appreciate that any of the bone plates can include locking,non-locking or a combination of locking and non-locking holes. Inaddition to the bone plates, screws and instruments described above, oneskilled in the art will appreciate that these described features can beused with a number of trauma treatment instruments and implants,including external fixators, ring fixators, rods, and other plates andscrews.

1. A tibia bone plate comprising: a head including a plurality of bone screw holes; a shaft disposed distally of the head, the shaft including: a first set of holes having first and second locking holes longitudinally spaced from each other; and a second set of holes disposed proximally of the first set of holes and having a dynamic compression slot and a third locking hole longitudinally spaced from each other.
 2. The tibia bone plate of claim 1, wherein every locking hole is a fixed angle locking hole.
 3. The tibia bone plate of claim 1, wherein the first dynamic compression slot is a bi-directional dynamic compression slot.
 4. The tibia bone plate of claim 1, wherein the shaft further comprises a third set of holes longitudinally spaced from each other and disposed proximally of the second set of holes, the third set including fourth and fifth locking holes.
 5. The tibia bone plate of claim 4, wherein the shaft further comprises a fourth set of holes longitudinally spaced from each other and disposed distally of the first set of holes, the fourth set including a sixth locking hole and a bi-directional dynamic compression slot.
 6. The tibia bone plate of claim 1, wherein the shaft further comprises a group of a locking hole and a dynamic compression slot longitudinally spaced from each other and disposed distally of the first set of holes.
 7. The tibia bone plate of claim 6, wherein the locking hole of the group is disposed distally of the dynamic compression slot of the group.
 8. The tibia bone plate of claim 1, further comprising a neck disposed between the head and the shaft, and comprises at least three kickstand holes.
 9. The tibia bone plate of claim 1, wherein the plurality of bone screw holes in the head includes a first row of bone screw holes and a second row of bone screw holes.
 10. The tibia bone plate of claim 1, wherein the head further comprises at least one k-wire hole.
 11. A tibia bone plate comprising: a head including a plurality of bone screw holes and k-wire holes; a shaft disposed distally of the head, the shaft including: a first set of holes having first and second fixed angle locking holes longitudinally spaced from each other; and a second set of holes disposed proximally of the first set of holes and having a bi-directional dynamic compression slot and a third fixed angle locking hole longitudinally spaced from each other; wherein the first and second set of holes are adapted to receive a bone screw and the hole disposed most distally among the first and second set of holes is a fixed angle locking hole.
 12. The tibia bone plate of claim 11, wherein the shaft further comprises a third set of fixed angle locking holes longitudinally spaced from each other and disposed proximally of the second set of holes.
 13. The tibia bone plate of claim 12, wherein the shaft further comprises a fourth set of holes longitudinally spaced from each other and disposed distally of the first set of holes, the fourth set including a sixth fixed angle locking hole and a bi-directional dynamic compression slot disposed proximally of the sixth locking hole.
 14. The tibia plate of claim 1, wherein the shaft further comprises a group of a fixed angle locking hole and a bi-directional dynamic compression slot longitudinally spaced from each other and disposed distally of the first set of holes.
 15. The tibia plate of claim 14, wherein the locking hole of the group is disposed distally of the dynamic compression slot of the group.
 16. The tibia bone plate of claim 11, further comprising a neck disposed between the head and the shaft, and comprises at least three kickstand holes.
 17. The tibia bone plate of claim 11, wherein the plurality of bone screw holes in the head includes a first row of bone screw holes and a second row of bone screw holes.
 18. The tibia bone plate of claim 17, wherein the head further comprises at least one k-wire hole.
 19. The tibia bone plate of claim 11, wherein the plurality of bone screw holes in the head includes a first row of bone screw holes and a second row of bone screw holes disposed distally of the first row of bone screw holes and are larger than the first row of holes.
 20. The tibia bone plate of claim 11, further comprising a plurality of spaced indentations configured to receive an aiming guide. 